Category Archives: Breastfeeding

Review: Ina May’s Guide to Breastfeeding

by Angie Sonrode

As a self-professed lactivist and lover of midwife Ina May Gaskin, I picked up  her book, Ina May’s Guide to Breastfeeding, with high expectations and a curious mind. Thankfully, and not surprisingly, I was not disappointed.

I have read many books on lactation and this one may have just taken the top spot on my bookshelf. This book is well-written from a warm, tender voice and chock-full of helpful, easy-to-follow information that is very reader- (and tired mother)
friendly. In addition, it is peppered with real
women’s stories and experiences.

Ina May knows how to grab your attention. On the first few pages she states, “You probably wouldn’t have picked up this book if you didn’t already have some idea of the benefits of breastfeeding and the possible undesirable consequences of feeding artificial milks to babies as a first choice.” This statement sets the tone of the book, as one clearly in favor of breastfeeding but it is also not her intention to pass judgment on mothers. She has found a way to promote breastfeeding with honest, well-rounded facts, while breaking down the components of breastfeeding so anyone giving it a go does so well informed.

One of the reasons I liked this book so much is that Ina May clearly understands not just the biology and physiology of breastfeeding, but also the social, economic and emotional factors that go into a woman’s breastfeeding experience. She touches on women in the workforce and their pumping dilemmas, sexuality and breastfeeding (yes, it’s possible to have a very normal and active sex life while lactating), and the connection of sleeping arrangements and the success of breastfeeding. While other books on parenting and breastfeeding have included some of these topics, none that I have read have managed to complete the puzzle— meaning that there are many, many factors that contribute to a mother/baby duo’s success or failure with nursing.

My favorite chapter in the book is titled “Shared Nursing, Wet- Nursing, and Forgotten Lore.” In this gem of a chapter Ina May discusses the benefits of community involvement in breastfeeding no matter the size of the community. She discusses induced lactation which is when someone that has lactated in the past re-lactates— including grandmothers and aunts, and also sympathetic lactation, which is when someone who has never lactated before can begin to produce milk if there is a need or she is in situations that raise her levels of oxytocin (a doula or midwife are examples).

Ina May also talks about the importance of recognizing that when a family suffers an infant loss, the effects of lactation need to be addressed and incorporated into the healing process. This is something often left out when helping parents in this unfortunate situation.

The book ends with Ina May talking about America’s “Nipplephobia” and the ramifications this has had on our breastfeeding rates and success stories. She goes into detail about how the U.S. was the only country in the world to vote against the WHO/Unicef Code of Marketing of Breast- milk Substitutes and that this decision has had an escalading effect on our meager breastfeeding rates. This is something we are still paying dearly for, with long-term effects.

When a society works hard to hide all aspects of nursing and breasts it in turn hides the primary reason women have breasts at all. If a culture of women and men grows up only seeing bottle-feeding it makes sense that this would be their perception of “normal.” Likewise, if a woman struggling with breastfeeding (as many new mothers do before they get the hang of it) is sent home from the hospital with formula samples she is much more likely to use

them than had the samples not been introduced.

I recommend this book to anyone interested in learning about the wonders of breastfeeding as well as those looking to further their lactation education—couldn’t we all?

Angie Sonrode is a birth doula and lactivist whose business is called Continuum Birth Services because she truly believes it takes a village. She is the mama to four wonderful children. 

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Breastfeeding: Just Get Out There!

by Liz Abbene

Making the decision to breastfeed is fabulous, but following through with that commitment is something many new mamas struggle with. One of the big obstacles mamas face is breastfeeding outside the home and in public places. While this is definitely different from nursing in the comfort of your own home, it shouldn’t be a source of stress or interfere with breastfeeding goals.

The first step to easily nurse in public is the same as nursing at home: get comfortable. This is a physiological requirement of breastfeeding. If you are uncomfortable, your body will not release the hormones essential for lactation. Many women are uncomfortable with the idea of exposing their breasts while nursing, but the reality is that when you are feeding, the baby actually covers up the majority of your breasts. Test this out at home—sit in front of a mirror during a breastfeeding session to see how little of your breast is actually revealed. Most likely you will not travel with your nursing pillow, so practice different positions that you can do without one or try nursing in a carrier to hold baby in place.

Another key element to successful breastfeeding in public is to dress appropriately. Usually all this requires is wearing clothes and a nursing bra that open easily for nursing and that provide you with the coverage you are looking for. Some women are very comfortable exposing bare skin, while others prefer not to. Either way is completely fine—personal comfort is what is important.

There are many types of nursing shirts available in stores or online. While they may be helpful, it’s not practical to completely replace your entire wardrobe. Instead, invest in several nursing camisoles which can be worn under shirts or sweaters. Another option is to wear a nursing bra and a stretchy tank or camisole under a regular shirt. Pull up the top layer, pull down the stretchy second layer, and open the nursing bra. Viola! You can nurse easily and discreetly.

Some mamas like to cover up with a blanket, shawl, or a nursing cover designed specifically for this purpose. Nursing covers are usually a piece of light fabric with a strap worn around the neck, and are designed to make it easy to see your baby while feeding.

Baby carriers such as slings and wraps can be great for nursing too, giving both coverage and support for the baby. These tools can be helpful, especially in the beginning when you and baby are getting the hang of things or with an older baby who is easily distracted by other things in the environment.

Once you’ve practiced a bit at home, get out there! The only way to really master the art of breastfeeding in public is to do it. Start by going to a friend’s home or a quiet coffee shop with comfy chairs. Going to the movies is a fantastic place to get used to breastfeeding outside the home—it’s dark and everyone is facing the opposite way.

When you’re getting baby started at the breast, try not to look around the room to see if anyone is watching you. Most likely, they’re not, and you’re apt to call attention to yourself by looking around. Maintain eye contact with your companions, and try to getting baby to the breast as quickly as possible. Do your best not to stress about it, and before you know it, you’ll be nursing with ease in every situation!

Liz Abbene, founder of Enlightened Mama, is a birth doula, birth doula trainer, Lamaze childbirth educator, breastfeeding counselor, wife, and mama to four amazing children. 

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Breastfeeding behavior…Is this normal?

Editor’s Note: This article originally appeared in a print edition of Collective Thoughts from 2010. 

 

by Amber Moravec, DC, FICPA

Breastfeeding has many obvious benefits. A common motivation for families is the nutritional value. Less obvious benefits to the baby are structural. Regular nursing at the breast aids the baby in cranial re-shaping and complete molding of the mouth, jaw, and tongue. Feeding at the breast induces rhythmic, deep breathing that supports the development of baby’s diaphragm, which is often tense from the birth process and/or under developed at birth. A tight diaphragm can cause increased incidence of crying or spitting up and can contribute to digestive issues like reflux and colic.

All is well when things go right, but parents often encounter situations after birth attendants or birth assistants leave. Normal, attentive parents start wondering… does every baby do this? Is this just a phase they will outgrow? Should I alert someone about this?

Some common behaviors and patterns in baby that warrant assistance from someone with experience in nursing or newborn care (such as a midwife, doula, pediatric chiropractor, cranial sacral therapist, or lactation consultant) are:

  • A nursingpattern of pulling away, latching on, pulling away
  • Prefers nursing on one breast over another
  • Jerks at the torso while nursing
  • Cries after nursing
  • Cries of frustration while latching
  • Spits up a notable amount after every feeding

The above observations and behaviors can be a sign of structural or functional distress, meaning that spinal misalignments, tight muscles, or ligaments (often due to restriction during the growth or birth process) can be causing discomfort for baby. Particular nursing positions or sleeping postures may also lead to distress in an infant’s growing body.
Baby’s diapers offer a guide to how well nursing is going. Adequate numbers of wet and poopy diapers say baby is getting enough to eat. Baby poop provides keen insight into their internal processes. After the meconium passes, exclusively breastfed babies should have mustard yellow, seedy stools that are loose in texture, with the consistency of pea soup or small cottage cheese-type curds. The odor should be mild and not unpleasant. Other textures, colors, or odors of poop should be considered abnormal.

An infant’s complaints can also stem from food sensitivities. Dairy and wheat are leading culprits when it comes to food allergies. Unless there is a strong family history of wheat/gluten issues most practitioners suggest starting with dairy elimination. Dairy tends to cause more problems and it is generally easier to remove from your diet. Restrictive dieting can be both difficult and overwhelming. This limiting diet will last a minimum of 15 days; to give both mom and baby time to purge the allergens from their systems and to respond to the absence of the irritant, if not longer. I recommend finding a professional who will provide you a list of alternative foods and strategies for success to aid you during that journey.

In many ways, breastfeeding is nature’s way of helping baby work through the residual effects of the birth process. The most experienced moms will often need four to six weeks of dedicated feeding at the breast to find a natural rhythm (every baby is different). Obstacles can happen to everyone, but in the end, a happy, content, healthy baby is a great payoff!

Dr. Amber Moravec, DC, FICPA is the mother of three beautiful children. She is a certified maternal and pediatric chiropractor and has completed extra coursework on the techniques and protocols of care for newborns, children, and pregnant women. Her practice is Naturally Aligned family chiropractic.

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Some Thoughts on Breastfeeding by Zoe C., age 10

Hi-

My name is Zoe and I am 10 years old. I think that breastfeeding shouldn’t be hidden because it’s a natural thing and if it’s natural it should be open. Everybody knows what it is, so it shouldn’t be embarrassing and if you feel embarrassed you can use a blanket or towel over the baby’s head or you could go into a private place to nurse. I don’t think people should give formula to babies because it’s not the real thing and it might have icky stuff in it and if you nurse from yourself it won’t have weird chemicals because it’s just from you! At the same time when you nurse, the baby gets to snuggle with you and gets to know you better and if you just give them a bottle they just do it themselves without the snuggles. What I’m going to do when I’m an adult, if I can, I will nurse my babies because I like natural things the most. Thanks for listening to my thoughts.

The above essay is submitted by Zoe Chinn, age 10, who lives in St. Paul, MN with her parents, a big sister, one cat, and a guinea pig.

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A Bottle in My Hand: A Poem about BFAR

by Liz Hochman, CD(DONA), LCCE

 

Yes this is a bottle in my hand

My judgement of myself is deeper,

than that glare you just gave me

 

Yes this is a bottle in my hand

and I am weeping every night,

in her bedroom all alone

 

Yes this is a bottle in my hand

but you do not know my story

and I hope you never live it

 

Yes this is a bottle in my hand

my love for her is strong,

and I hope she doesn’t hate me

 

Yes this is a bottle in my hand

because I made a choice a million years ago,

to change the shape of my breasts

 

Yes this is a bottle in my hand

to change the curving of my spine,

as my body listed forward from the weight that I carried

 

Yes this is a bottle in my hand

my breasts with a map of scars,

that tell the tale of choices that I’ve made

 

Yes this is a bottle in my hand

of breastmilk that I drained,

like the pain from my heart

 

Yes this is a bottle in my hand

and I love her so much

that I give her what she needs

 

with a bottle in my hand

 

Editor’s note: This poem was written by a BFAR (breastfeeding after reduction) mama. Breast reductions and other breast or nipple surgeries can have an impact on milk production and overall breastfeeding. For more information and support, please visit bfar.org

 

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Beyond the Boob: helpful breastfeeding tools and supplies

by Kate Saumweber Hogan, CPM, LM

What do you need to successfully nurse your baby? Well, if you are already pregnant, then quite simply, you already have what you need: you baby and your breasts!

Some babies love to nurse upon arrival, and already know how to be a masterful nurser…and others need a lot of support and guidance. Remember, there are two people in the breastfeeding relationship, so even if mom is doing everything “right,” baby still has to do his part of the job too.

Keeping a relaxed attitude and a sense of humor can go a long way in a nursing relationship. Since babies can feel your stress and anxiety, laughter can help to keep all of those good hormones and bodily fluids flowing!

What about all of that other breastfeeding stuff on your suggested baby registry list? Here is my list of things to consider having on hand:

  1. A good nipple cream: If this is your first time nursing, there will likely be at least a tad bit of nipple soreness. If you get nothing else, it would be useful to have a good nipple cream already on hand; many moms start using it in the first 24-48 hours. In my practice, moms most often prefer Motherlove’s nipple cream and Earth Mama Angel Baby Natural Nipple Butter. These two seem to not only protect, but also heal nipples faster than some of the other common nipple creams out there. You can find these online, at Whole Foods, and also at some of our local birth related business around town.
  2. Gel pads: At the first sight or sense of any nipple cracking, bleeding, or blisters, you’ll want to start using gel pads. Even if your breasts are just feeling tender between nursing sessions, you can start using these to help protect your nipple from rubbing against fabric of your bra or shirt. These incredible little inventions are like a gel sticker that helps protect and heal the nipple. You can use them in conjunction with nipple cream (after nursing apply some nipple cream, and then apply the gel pad). The two brands I recommend are Madela’s Tender Care Hydrogel Nursing Pads and Lansinoh‘s Soothies Gel Pads. Sometimes partners will put them in the fridge during a nursing session, and then you can apply the cool pads after baby is done eating. They are meant to be reused for 24-72 hours. I think it is nice to have at least one box of these on hand, especially for first time moms.
  3. Nursing tank top: You won’t be able to pick out a nursing bra until your milk has come in and your supply has eve
    A mama nurses immediately after birth. Photo credit: Allison Kuznia Photography

    A mama nurses immediately after birth. Photo credit: Allison Kuznia Photography

    ned out (a great outing for 2-3 weeks postpartum), but it might be nice to have some stretchy nursing support options for the first couple weeks.  Nursing tank tops are tanks with some light support built in, while also allowing you to unclip from the strap to give your baby access to your nipple. Night nursing bras are like stretchy sports bras, and you would likely be able to pick out one that fits at the end of your pregnancy, that will stretch enough to support you through the first couple weeks.

  4. Breast Pump: If you are planning to get a pump at some point, it can be nice to have it prior to labor. It is rare, but every once in a while it is nice to use a breast pump in labor to help stimulate contractions (nipple stimulation releases oxytocin, the natural form of pitocin, which brings on labor surges). Be sure to check to see if your insurance covers your breast pump; most plans do! I’ve been hearing lots of recommendations for the Hygeia breast pump lately since it is a closed system which is rated for multiple users. Since the milk can’t get into the motor, it is okay to share this brand of pump (of course with new tubing and parts each time), and you don’t have to worry about mold or dust getting into the motor. Most pumps aren’t meant to share, so be sure to do your research if you are considering borrowing a friend’s or buying one used on craigslist.
  5. Hands Free Pumping Bra: If you are going to need to pump regularly (such as going back to work), then you will absolutely want a hands free pumping bra. This super smart apparatus holds your pump flanges securely to your breasts while pumping, freeing up your hands to do other things. Think of things like checking email, doing paperwork, reading a book, updating Facebook, even driving (just make sure you set it up before you pull out of the garage…and not recommended with a convertible or motorcycle), all while expressing milk! It will allow you to truly multitask, and maybe even justify a bit of extra mommy zone-out time!
  6. Lactation Consultant contact info: Breastfeeding shouldn’t be painful! Other than a little latch pain which fades away after 10-15 seconds, and a bit of tenderness in the first few days as your nipples adjust to nursing, breastfeeding shouldn’t hurt! If it does, then something needs to be adjusted. Most often it is the latch, sometimes it’s positioning, or it could even be a baby’s short frenulum. Whatever the issue may be, you do not need to problem solve alone. We are in an amazing community that is full of support. Be sure to check out the Childbirth Collective’s member directory to get in touch with a lactation support specialist. You can even request a few hours of lactation help or postpartum doula support as a baby shower gift!
  7. Privacy and Rest: Unlike many other cultures around the world, we don’t have a huge tradition of postpartum rest and pampering (unfortunately!). It is so important for you and your new family to get lots of skin to skin time together, and sometimes that can be hard to do in front of visitors. When baby arrives, allow yourself at least two weeks of lounging in bed, with minimal visitors, so that you and baby can figure out what works best for you, in your own time and pace. Have your lactation consultant and other support people come to you, so that you aren’t wearing yourself out by having to get dressed, get a diaper bag packed, and get yourself out of the house so early on.

Surround yourself with love and support, keep a lighthearted attitude, and please please please ask for help at any early signs of breastfeeding troubles. Happy nursing!

Kate Saumweber Hogan is a certified professional midwife and licensed midwife, serving Minnesota and Wisconsin. She is the owner of Twin Cities Midwifery where she provides prenatal, home birth, newborn, and postpartum care. She sees families at clinic spaces in Minneapolis and White Bear Lake, and lives in south Minneapolis with her husband and nursing daughter, born at home in the water in December 2012.

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Finding Breastfeeding Support: The Right Tool for the Job

Photo Credit Constellation X Photography by Cat Banks

Photo Credit Constellation X Photography by Cat Banks

by Tiffany Jensen Gallagher, CLC

Have you ever tried to open a package, and instead of walking across the room to fetch the tool that would slice the package right open, you reach out for whatever is most convenient and spend 10 minutes tearing away at your child’s latest 1,000-piece toy monstrosity when you could have had it done faster, more efficiently, and with less mess if you had only taken the time to grab the right tool in the first place?

Getting the right help for breastfeeding is almost the same.

Doctors, nurses, midwives, and doulas can all be incredible sources of support during and after pregnancy, but unless they have received specific training in lactation and have kept up-to-date with the latest research and guidelines, they may not be the best source for information about breastfeeding and practical assistance with managing breastfeeding difficulties. The results of one survey  published in the Journal of the Academy of Nutrition and Dietetics states that 51% of physicians surveyed reported little to no education about breastfeeding; only 9% reported that they felt they have received adequate education on the topic. A similar survey published in the Journal of Midwifery & Women’s Health showed that 70% of respondents considered themselves effective or very effective in meeting the needs of breastfeeding patients, but, still, they were less knowledgeable about specific management strategies. Birth and postpartum doulas who are certified by DONA are required to have approximately three hours of breastfeeding education, which—compared to the 1,000 hours of support some lactation consultants must obtain before they even sit for the certification exam—is not very much at all.

IBCLCs (usually known as “lactation consultants”) are the experts on breastfeeding. They’ve done hours upon hours of supervised clinical work with mothers and babies dealing with a wide variety of circumstances; taken various college-level and lactation-specific coursework; and have passed a rigorous exam. They must recertify every five years and, in the meantime, keep up-to-date on their knowledge about lactation by taking continuing education courses. IBCLCs can help with the most difficult breastfeeding problems, as well as provide support for moms in the normal course of breastfeeding. Some doctors, nurses, midwives, and doulas are IBCLCs, but unless someone has those letters after their name, they are not a lactation consultant.

CLCs (Certified Lactation Counselors) could be thought of as foot soldiers of the lactation-support world. CLCs have gone through a 45-hour course about lactation and have passed an exam. Recertification, which happens every three years, requires continuing education. For many, the education ends there, but there are others who make breastfeeding their passion. I’m one of those, and I spend a very large chunk of my time reading, writing, and learning about breastfeeding, in addition to helping families overcome problems and meet their breastfeeding goals. There are more CLCs out there than IBCLCs, and they are your go-to folks for helping with minor breastfeeding issues and helping families along the normal course of breastfeeding. Some doctors, nurses, midwives, and doulas are CLCs, but unless someone has those letters after their name, they are not a lactation counselor.

Why is it so important to use the right tool (in this case, the right person) for the job? Sometimes small, seemingly insignificant or innocent suggestions can have the potential to negatively impact breastfeeding.

For example, it’s not unusual for a mom to arrive at her baby’s first doctor’s appointment to find that a baby has lost a certain percentage of his birth weight. It is absolutely normal (and expected) for a baby to lose some weight after birth, especially if a mom has received IV fluids. Lactation professionals know to consider if fluids were received and to calculate weight gain from the baby’s lowest weight instead of a baby’s birth weight. However, since many doctors do not have a good understanding of how breastfeeding works or what is normal, the doctor may suggest a supplemental bottle, which, if not managed properly, is quite likely to lead to further problems down the road. The immediate issue—helping a baby gain weight—is fixed, but breastfeeding is not supported in the long term.

What a doctor, nurse, midwife, or doula should do—and what any professional, in any field, should do—is refer a patient or client to the best person for the job. As a CLC, there are some questions I cannot answer or issues I cannot resolve within my scope of practice, and I readily refer to IBCLCs, doctors, midwives, or other care providers. One of the signs of a professional who knows what she is doing is, in my opinion, whether or not she’s willing and able to refer clients to the best resources possible.

If you’re experiencing breastfeeding difficulties or have questions about breastfeeding, I do hope that your care provider is armed with good, evidence-based information and can help support you on your journey. If you feel that your needs are not being addressed, ask for a referral, or seek out a lactation professional on your own. You’ll thank yourself for taking the extra step to reach for the right tool.

Tiffany Gallagher, CLC is a Certified Lactation Counselor, WIC peer breastfeeding counselor, and postpartum doula serving families in and around the Twin Cities. Known as The Boob Geek, she’s a member of The Childbirth Collective and Pregnancy and Postpartum Support Minnesota, and loves to help families be the families they wish to be.

References:

http://www.journals.elsevierhealth.com/periodicals/yjada/article/S0002-8223(05)01554-3/abstract

http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(00)00010-6/abstract

http://kellymom.com/bf/normal/weight-gain/

http://www.theboobgeek.com/blog/putting-scope-under-the-scope.html

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